Mass Incarceration: The H.I.V. Engine

Despite making up only 12 percent of the population, Black women represent 60 percent of all HIV infections in women in the United States. In fact, the rate of H.I.V. infection is 20 times higher among Black women compared to White women, making up 57 percent of all new cases. These higher rates have often been attributed to racial differences in risk behaviors associated with drug use or sexual occurrences; however, “African Americans report less risky drug use and sexual behaviors than their White counterparts” in general. Indeed, new research has increasingly pointed to a much larger player at hand: the mass incarceration of Black men in the United States. The United States makes up five percent of the world’s population, yet it encompasses up to 25 percent of the world’s prison population, a majority of whom are racial minorities. Ever since the declaration of the War on Drugs in 1971, a government-led initiative that aimed to combat illegal drug use by increasing penalty sentences and drug arrests, as well as militarizing law enforcement, the rate of incarceration has spiked exponentially. In her book, The New Jim Crow, Michelle Alexander stated that “more than 31 million people have been arrested for minor drug offenses since the drug war began. Nothing has contributed more to the systemic mass incarceration of people of color in the United States than the War on Drugs.” 

But what does this racialized hyper-incarceration of Black men have to do with the increased H.I.V. infection rates of non-incarcerated Black women? The answer is the culmination of a number of factors, the first of which lies in the high rates of H.I.V. infection in prison populations owing to the War on Drugs’ mass-arresting of individuals involved in drug-related activities. This introduced a large number of individuals who were at high risk of being infected with H.I.V. into the penal system and concentrated them in one area. According to Dr. Robert Fullilove, a public health researcher and member of the Faculty of Public Health at Columbia University, these mass arrests led to a substantial increase in the rate of H.I.V. infection within the prison population. During a time when H.I.V. began circulating within communities and “there was probably a rapid rise in the number of people using drugs and sharing needles, we decided to send everybody to prison. It’s a way of saying that the group of people that had the greatest risk of exposure to H.I.V. was precisely the one that was targeted for incarceration.” He notes that by 2010, there were over 2.2 million individuals behind bars and 6 million people on parole or under the supervision of the court, all of whom represent “a substantial portion of the adult population [who are] in a setting where there is a high concentration of H.I.V. [and] where there is a great deal of circulating in and out of the community… You’re suddenly finding that more than anything else for a condition that we could not treat effectively and that was routinely fatal.” This high concentration of H.I.V. infection that began during the 1970s continued with the lack of access to protection in sexual interactions, higher rates of sexual assault, overcrowding, and transmission of the virus through shared needles from drugs and tattoos in prisons, drastically increasing inmates’ probability of acquiring the disease. Through a cycling of individuals in and out of the penal system, the rate of H.I.V. transmission into communities predominantly comprised of people of color also increased. Indirectly, however, mass incarceration can also facilitate the rupturing of relationships by reducing the number of men in Black communities which, in turn, increases the number of partners each man has and the rate of transmission. “When matching individuals by their propensity for incarceration, individuals who had been incarcerated had 4.34 (stratified analysis) to 4.76 (nearest neighbor score matching) more partners over the lifetime compared to individuals who had never been incarcerated, and there was no difference in the number of partners in the past year.”

However, this doesn’t indicate that incarcerated Black men are the sole cause of high H.I.V. rates in their communities; the answer is much more complicated. Dr. Fullilove suggests that mass incarceration doesn’t simply disrupt relationships by imprisoning a considerable portion of an adult population, it weakens communities’ overall capacity to organize effective, coordinated efforts to combat the threat that H.I.V. poses to individuals. Stigmatization of H.I.V., due to its association with male-to-male sexual contact, causes infected individuals to be averse to treatment out of fear of ostracization from their communities. “People would identify themselves as having been infected with the disease, but would absolutely not go to treatment or take drugs because they didn’t want others to find out that they were living with this infection… [this] kind of behavior makes it almost impossible to have a mounted, coordinated response to the kind of threat that H.I.V. represented.” Even if one does intend to seek treatment, the expensive cost that comes with it can cause enormous financial strain. A permanent criminal record often makes it difficult for ex-offenders to find a job and ensure economic stability, making treatment an impossibility. A survey published in 1996 showed that 65 percent of all employers would not intentionally hire an ex-offender, and a criminal record automatically disqualifies applicants from being hired in the health, education, law, and real estate sectors, as well as denies them the right to apply for public housing assistance, education, and public benefits. By the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, “‘persons convicted of a state or federal felony offense involving the use or sale of drugs are subject to a lifetime ban on receiving cash assistance and food stamps.’” These social factors can prevent infected individuals from getting treatment and facilitate a renewal of risk behaviors, further circulating the H.I.V. virus within marginalized communities.

Undeniably, the elevated rate of H.I.V. infection within Black women is tied to the overarching phenomenon of mass incarceration, and to minimize this recurring health disparity, one must shut down the intermediaries spurring it. “Ending H.I.V. in the USA can only be done by ending H.I.V. in Black America… The concentration of H.I.V. within marginalised subgroups within Black communities is arguably the manifestation of the systems of oppression at the intersection of racism and homophobia, sexism and misogyny, transphobia, and youth vulnerabilities. Ending HIV cannot be accomplished without dismantling these systems of oppression.” This can include reducing the number of individuals who enter prison, investing in resources that help ex-offenders reintegrate into mainstream society and contribute to the national economy, and, more generally, engaging in open conversations about mass incarceration that increase awareness among the general public. By waiving incarceration as penalty for low-level drug offenses (which are often committed by nonviolent individuals) and first-time offenders (especially those with mental health illnesses), prison spaces can be reserved for individuals who truly pose a significant threat to the public and instead elevate public safety. “Cost-effective” programs, such as the Bard Prison Initiative, seek to increase the level of education among incarcerated individuals and help them reintegrate into and become contributing members of society, as well as guide them on how to “maximize the ability of health care systems to invest and engage in the reform of the inequities produced by systems of incarceration and, in so doing, to increase access to resources that promote health and prevent disease.” Drug treatment programs can also ensure individuals receive the help necessary to rehabilitate, avoid recidivism, and re-enter society. This cruel system of mass incarceration can be toppled. We just need to take the first step, initiate that first of many conversations, and lend that helping hand. Sometimes, the willingness to understand and give a second chance are all that is needed to change the lives of millions for the better.